Consequence of flattening the curve

Early in the COVID19 situation, there was promotion about how social distancing and restrictions on businesses will slow the spread of the disease. Models predicted that these actions would keep the demand on healthcare services within the capacity. I complained earlier that the models showed that the capacity was a static number indefinitely.

If the economy was shut down, the supply chains for the medical system would degenerate. More significantly, shutting down the economy, and schools in particular, will lower the numbers for future healthcare workers to fill in for those who leave the healthcare industry. The more tedious work such as in actual COVID wards is best suited for younger people because of the need for physical strength, endurance, and strong immune systems. There needs to be a steady supply of new workers to replace those who can no longer do the work. Also, the new hires will not have the same enthusiasm as their predecessors. The predecessors entered with a passion for health care, but the new hires are entering reluctantly because other options are not available.

On the flip-side, the capacity could grow to meet demand. Keeping the economy open would make this elasticity to happen. An even better option would be to open the economy even further, especially in terms of removing restrictions on who can enter the healthcare industry. Given the very specific demands for handling COVID cases, there would be a new class of workers trained specifically for handling the bulk of the COVID cases. Their training would be quick and they would be able to work within weeks instead of many years currently required even for nurses. There could also be a more lenient qualification for facilities to house the sick. The qualifications may include specific instructions to contain the infection, but many other requirements on hospitals may be relaxed. The focus is on treating the acute symptoms of the disease. Once that is resolved, the patient may resume normal healthcare protocols for their healthy checkups or for their chronic issues.

We chose to close down the economy. More specifically, we shut down the economy of smaller businesses that cater to local customers or to very narrow niche markets. As I walk through town, I see many businesses that have closed permanently. The remaining ones that are still open are definitely having a much lower business volume than before, and I recall hearing that their margins were already very thin at that time.

A year after the promotion of the curve-flattening agenda, hospitals and healthcare facilities have survived. Throughout the pandemic, the healthcare industry was losing money because regularly-expected patients stopped seeking care for a variety of reasons. Currently, there is a marketing campaign to remind people to return to the normal healthcare service schedules. These campaigns emphasize how safe they are. Perhaps that will bring in some customers. I suspect a large number of would-be consumers of not interested in services by a fearful practitioner.

I recall my last visit to the doctors and he wanted to listen to my lungs when I breathed deeply. The mask I was wearing was restricting how much I could breathe. Even more disappointing was to see that he was fine with this. Prior to COVID, I would be scolded for not breathing deep enough. Now, a shallow breath suffices.

I occasionally hear advertisements for certain healthcare services such as cancer treatments or screenings. The advertisements sound like they are trying to remind people that such services exist. Prior to COVID, the advertisements were about why one center would be better than the rest. Now, the emphasis is that they offer the service. I think many people with cancer conditions and risks are not seeking care.

As this situation continues, the hospitals will need to downsize their departments for handling these cases. The professionals will leave or transfer to other disciplines. The spaces will be converted to other uses, and specific equipment with be disposed. This is an example of the capacity line bending downward as opposed to being a flat horizontal line depicted in the marketing agenda of the flatten the curve. There are predictions of a future calamity when the advanced cancer cases start to show up in great numbers at the time when the capacity for handling these cases will have been reduced. The new case numbers would greatly exceed normal numbers prior to COVID. The available capacity will be lower than what supported normal numbers prior to COVID. The agenda for flattening the curve does not work for chronic illnesses and conditions.

I think the overall public policies of the past year failed their objectives to save the healthcare system. We lost the health care system we had prior to COVID. Something new is replacing it, but I don’t think it will be as effective and as efficient as the old system. Hospitals are increasingly places to go to when it is time to die, and the final hours will be spent dying alone in rooms equipped with sufficient electronics to allow health providers work remotely.

In the normal workplace, the tendency is to allow people to work from home as much as possible. This is also applying to the medical practices. At the very least, they can operate in spaces where they would not have to directly interact with patients.

The one time you are not allowed to stay at home is when you need healthcare services. To get these services, you need to go to a medical facility of some sort. When you arrive, you will be treated as a hazard. The receptionists are behind glass and any exchanged documents are sanitized. The actual visit involves as much distance as possible. I would not be surprised if there are system the patient to escort himself to the appropriate rooms and even do his own measurements. The interaction with the health provider will be through cameras and intercoms.

There are many healthcare technologies that are accessible to consumers. We can acquire adequate technologies to do at home what we once needed a doctor’s visit. Many of these are offered at the local drugstore. These include kits for sending samples to a laboratory. We are close to having the ability to set up a intensive care unit in our own homes at least in terms of the monitoring and the tubes. We lack only the ability for someone to show up quickly when a serious event occurs. I believe that is possible but it needs a very different health care industry.

It should be possible to be a tele-patient analogously to how we are able to telework. Like with telework, there needs to be some compromises. The effectiveness will be different. I do agree with doctors who say that telemedicine cannot replicate what an in-person evaluation can do. However, the same complaint exists with teleworking for other jobs. Over time, the conditions adapt, and we learn.

There is a convincing argument that teleworking is reaching the point where the work that can be done while teleworking cannot be done in the office. For example, teleworking permits a just-in-time type labor. People can be available when the work is needed, and free to do other things when they are not needed. This just-in-time nature is appropriate for health care. Most of the time a patient spends in a hospital bed, they could be in their own bed with the appropriate supplemental technologies. The intensive care component involves rapid attention from a health provider when it is necessary. This currently only can happen in a hospital setting, but a different healthcare model may be able to accomplish this for patients who are at their home. The model may involve robots, or it may involve lesser qualified practitioners who happen to be living nearby.

The alternative model may also include a compromise that some acute conditions simply cannot be attended to in time. We should be able to accept this compromise. In normal life, there are situations where people find themselves in life-threatening situations without the immediate access to a life-saver. These occur daily in various accidents, failures, or victims of homicidal intentions. When the accident occurs, the person is dire circumstances but we accept that the necessary help will not arrive in time. That acceptance can also occur in a situation occurs within a home healthcare system.

The impact of the policies of the past year or so is affecting all aspects of life, not just healthcare. Currently, there is concern about inflation. Supply shortages are a significant contributor to the inflation. These supply shortages should have been a completely predictable consequence of allowing only essential workers. The definition of essential workers was at the final distribution end of the supply chain. The upstream providers are not essential in any immediate sense, so they have to reduce capacity or shut down entirely. Eventually a time would come with their lack of productivity would show up in lower stockpiles for distribution. This appears to be happening now with many commodities.

I suspect a larger factor for the supply shortages is the change in demand. This is very obvious in the building industry. Due to the severity and apparent permanence of the social-distancing restrictions, people are moving to locations with more space between neighbors and more space in the home. This is a geographic shift so that people want homes that do not exist. There are so many houses being built that there are shortages in both material and in labor, where both have already been artificially suppressed by being non-essential.

The government policies of the past year are directly responsible for these shortages and thus for the rising inflation. The policies had the explicit requirement to slow down production and to idle workers. In addition, the government had the juvenile expectation that people will not change their habits. While the government speaks of a new normal, that new normal assumed that people would want the same kinds of thing. The new normal was providing people’s previous wants through different means.

Without government intervention, the normal market makes the opposite assumption. Peoples behaviors are always changing and there is an innovative part of the market that attempts to predict what the future different behaviors will be. The market covers multiple scenarios so there is usually at least one offering that satisfies a new demand.

The government’s new normal expected people will want to remain in cities even though they are encouraged to stay at home and have everything delivered, including food, while living in cramped apartments or condos. People rented or owned city residences with the assurance that they would spend most of their day outside of those locations. The city life includes spending substantial time in an office, or on the road. It includes spending substantial time in retail or restaurants. If people have to spent the majority of time inside their home, they will want to have a larger home and live where a larger home is affordable.

The housing supply shortage has other contributors such as speculators and investors. These too are a consequence of the earlier government policies. Speculators would notice the trend early on and then begin investing on the expectation that even more people will want to escape the city, or escape their smaller houses. They would build larger houses in more places, and this would further strain the supplies of material and especially of labor.

There is mention of acute labor shortages throughout the economy. Despite the large number of people who are not working or are not working as many hours as before, businesses are having to offer higher wages to entice people to work there. This is occurring in service industries like restaurants or retail stores. There is a pool of potential workers but they are not applying for the positions. The business offers a higher compensation and those that are lucky enough to get the staff will have to increase costs to their customers to pay for the new labor costs.

More troubling is the shortage of labor in jobs that require extensive training or certifications. I saw a report that noted that older workers are retiring ahead of their usual schedule. This should have been predictable from the start. First the fear factor is telling people that they may not have as many years to live as they originally thought. I think a bigger factor is the lost appeal of work due to the new working arrangements. A much as people complain about their commutes and their office arrangements, the nature of working in an office is very different from working remotely. For more senior workers, the office arrangement offers the opportunity to engage with more junior workers to get them to help with the work, and in the process develop those workers for future advancement.

The telework arrangement inherently expects everyone will stay the same forever. The senior workers will also have the senior roles. The junior workers will always have the junior roles. The government effectively decided that training and career advancement is non-essential in times of a pandemic. Some older workers may be dropping out because their own advancement opportunities are closed off, in part because there is no one who is trained to fill their vacancy.

At the same time, the younger worker is being lured into a sense that they can continue their current level indefinitely. They are turning the junior position into a lifelong career goal. They are not getting the incentives to pursue advancement. Instead they are striving to make their current conditions more lucrative.

I think about the example of many content producers on video platforms like YouTube. Many people started making money on these platforms and are working to increase their earning potential by appealing to larger audiences. Some are getting very successful doing this, and many of those have mediocre production qualities. They are managing to get paid well doing something that is barely advanced from what they started doing. Most are not on the path to creating a major studio.

On that topic, I recognize many are advancing. There are some channels with very high production values both in the presentation and in the research. They are earning the a senior status on their own and are seeking to employ people to help them out. This is admirable but it is in the online video market. Their skills and aptitudes would help greatly to fill in some of the critical openings in corporations or in industries. To be fair to them, they are probably earning more doing the videos than doing the corporate work.

Many others are at least spending much of their career efforts trying to capitalize on these alternative work models. They are not preparing themselves for eligibility for the these corporate positions. The corporations are responding with more lucrative offers, but also with more openness to accept people who do not meet the standard degree or credential requirements. This is causing further enticement for the older workers to leave.

This trend of upsetting the normal arrangements will continue. While this is happening there will be more shortages. Supply chains will dwindle due to government restrictions and due to the lack of labor. The supplies that are delivered will have inflated costs due to high demand or due to the need to pay for the higher labor costs. The ultimate result is high inflation.

The government started this. I do not think government was wise enough to see the current situation as a risk, and this has greatly reduced my respect for government. If they did include this risk in their calculations, they clearly decided to sacrifice the future for their fears at the time. The evidence is that they exaggerated this fear, and this exaggeration also reduces my respect for government. There is no way the government’s actions over the past year looks admirable.

There could be some good outcomes to all this. It probably will take the rest of this decade to work out, but there will be some good changes. The changes that happen will be in response to bad government decisions, and also in spite of continued government interference. I think it is just as likely that government will prevail in dragging the entire world down to their need for control the population to relieve their fears about all the calamities science predicts will happen if governments do not act.

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